Thoracic Outlet Syndrome

Question 1

What is the thoracic outlet?

Answer 1

Space between the clavicle and 1st rib where the subclavian vein/artery and brachial plexus pass through

Question 2

What is thoracic outlet syndrome?

Answer 2

Compression of this area leading to neurological, arterial and venous symptoms

Question 3

What are the causes?

Answer 3

Excessive muscle development
Cervical rib- extra rib above 1st
Healed clavicle fracture

Question 4

What are the symptoms?

Answer 4

Neurological

• paraesthesia of inner forearm
• wasting of small muscles in hand- difficulty gripping objects

Arterial

• upper limb claudication when working with hands above head
• post stenotic dilatation= aneurysm which can thrombose and cause occlusion

Venous
-dilated limb due to venous obstruction

BP normally lower in affected side and varies with posture

Question 5

What investigations are needed?

Answer 5

CXR to look for cervical rib/anatomical abnormalities and rule out tumour

Arteriography to confirm diagnosis

Question 6

What is the treatment?

Answer 6

Neurological= education, rehab and physio

Surgery if this fails or if anatomical defect